腹腔镜胰腺肿瘤剜除术后胆道并发症的危险因素分析  

Risk factors of biliary complications after laparoscopic pancreatic tumor enucleation

作　　者：乔梁[1] 熊光冰 冀旭 袁天 汪小祥 朱峰[1] QIAO Liang;XIONG Guangbing;JI Xu(Department of Biliary-Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,湖北武汉430030

出　　处：《腹腔镜外科杂志》2024年第3期189-193,共5页Journal of Laparoscopic Surgery

基　　金：国家自然科学基金青年科学基金项目(81902499);国家自然科学基金面上项目(81874205);2023年同济医院科研基金重点项目(2023A18)。

摘　　要：目的:探讨腹腔镜胰腺肿瘤剜除术后发生胆道并发症的危险因素。方法:回顾分析2017年3月至2023年6月101例接受腹腔镜胰腺肿瘤剜除术患者的临床及随访资料。其中男29例,女72例,15~77岁,平均(48.6±13.2)岁。肿瘤位于胰头部49例(48.5%)、胰颈体尾部52例(51.5%)。根据术后是否发生胆道并发症分为胆道并发症组(n=24)与无胆道并发症组(n=77)。单因素分析中定量数据采用t检验或Mann-Whitney U检验进行比较,分类数据采用χ^(2)检验进行比较,采用多因素Logistic回归分析术后发生胆道并发症的独立危险因素。结果:患者均在腹腔镜下顺利完成肿瘤剜除术,无术中输血及中转开腹,手术时间63~359 min,平均(168.0±58.7)min。术后长期随访,24例(23.8%)发生胆道并发症,其中胆囊结石21例、胆囊炎2例、胆囊结石合并胆总管结石1例;77例(76.2%)未发生胆道并发症。单因素分析结果显示,体重指数大(P=0.008)、术后第1天γ-谷氨酰转移酶高(P=0.04)、肿瘤位于胰头部(P=0.012)、肿瘤最大径长(P=0.028)、生长抑素使用总量多(P<0.001)是术后发生胆道并发症的危险因素。将上述危险因素纳入多因素Logistic回归分析,结果显示体重指数大(OR=1.262,95%CI=1.025~1.554,P=0.028)、肿瘤位于胰头部(OR=4.042,95%CI=1.242~13.155,P=0.020)、生长抑素使用总量多(OR=1.381,95%CI=1.059~1.800,P=0.017)是腹腔镜胰腺肿瘤剜除术后发生胆道并发症的独立危险因素。结论:腹腔镜胰腺肿瘤剜除术是治疗胰腺良性、低度恶性肿瘤的有效术式,对于具有上述危险因素的患者,应在出院后加强监测胆道并发症的发生情况。Objective:To investigate the risk factors of biliary complications after laparoscopic pancreatic tumor enucleation.Methods:The clinical and follow-up data of 101 patients who underwent laparoscopic pancreatic tumor enucleation from Mar.2017 to Jun.2023 were retrospectively analyzed.There were 29 males and 72 females,with the average age of(48.6±13.2)years(range:15 to 77 years).The tumors located in the head of the pancreas in 49 cases(48.5%)and in the neck and tail of the pancreas in 52 cases(51.5%).According to the presence or absence of biliary complications,the patients were divided into biliary complications group(n=24)and non-biliary complications group(n=77).In univariate analysis,quantitative data were compared by t test or Mann-Whitney U test,and categorical data were compared byχ^(2) test.Multivariate logistic regression analysis was used to analyze the independent risk factors of postoperative biliary complications.Results:All patients successfully underwent laparoscopic enucleation without intraoperative blood transfusion and conversion to open surgery.The operation time was(168.0±58.7)min(range:63 to 359 min).After long-term follow-up,biliary complications occurred in 24 patients(23.8%),including 21 cases of gallstones,2 cases of cholecystitis and 1 case of cholecystolithiasis combined with choledocholithiasis.Seventy-seven patients(76.2%)had no biliary complications.Univariate analysis showed that higher body mass index(P=0.008),higherγ-glutamyl transpeptidase level on the first postoperative day(P=0.04),tumor located in the head of the pancreas(P=0.012),longer maximum tumor diameter(P=0.028)and more somatostatin dosage(P<0.001)were risk factors for postoperative biliary complications.The above risk factors were included in multivariate logistic regression analysis,and the results showed that high body mass index(OR=1.262,95%CI=1.025~1.554,P=0.028),tumor located in the head of the pancreas(OR=4.042,95%CI=1.242~13.155,P=0.020),and large amount of somatostatin dosage(OR=1.381,95%CI=1.059~1.800,P=0.

关 键 词：胰腺肿瘤 腹腔镜检查 肿瘤剜除术 手术后并发症 胆道 危险因素 

分 类 号：R735.9[医药卫生—肿瘤]